“THE truth is ... NHS is not free and is full of private provision” was your headline for Andy Maciver’s excellent column and he did not disappoint by hitting the bullseye on a number of issues often misrepresented by our elected representatives.

There is so much hogwash and humbug written about the health service, it was refreshing to read this unsentimental appraisal of “our wonderful NHS” as dewy-eyed politicians blindly parrot endlessly.

For example, Mr Maciver explains (accurately) that the NHS is not the envy of the world and is “average or slightly below” when compared to similarly funded health services in other modern countries. Also, nearly every GP in this country works for a commercial company and they bill the NHS for their services in order to make a profit.

This will come as news to many readers because politicians treat the NHS as a sacred cow. They only pay homage to it and offer no new constructive ideas or criticism of the service because of the near-certain political backlash of bogus accusations such as “privatising our NHS” and the like.

Sadly, the NHS is a political hot potato and, apart from chucking money at it, politicians leave it well alone in the hope it might sort itself out. It will not. It is long past time that political parties all recognised that the present NHS model (not the principle) is unsustainable and needs radical overhaul. As people grow older and require more and increasingly expensive treatments, it is impossible to see how this can be adequately provided and financed in the present health service arrangement.

A Royal Commission without political interference is needed to design a 21st-century health service to replace an NHS which is not fit for purpose. The present health service has grown like an untended garden from seeds sown by Aneurin Bevan in 1945 and it shows.

James Miller, Glasgow G12.

ANDY Maciver reminds readers, somewhat patronisingly, that the NHS does not come free.

Those who have been fortunate to have survived well into their senior years without suffering major illnesses en route are no doubt glad to support those who have been less blessed. This is the generally accepted principle on which the NHS was established in 1948 and which brought with it the freedom from fear of being unable to take advantage of healthcare at a time of need.

There are some would criticise those who require treatment as a result of a “self-inflicted” lifestyle and one can have an element of sympathy about this point of view. However, this would tend to ignore those who end up requiring treatment as a result of their decision to participate in high-risk activities which result in injury and which may involve rescue services funded by the public purse.

Comparisons are drawn between the sums spent per head of the population in various parts of the UK and in other countries worldwide where healthcare is state-funded. Averages can be deceptive as insufficient account is sometimes taken of the time patients spend in hospital and the number of hospital beds involved in various countries. Health and social care are combined in the UK and this is not necessarily the case elsewhere when comparisons are drawn. Even within the UK there are considerable variations between health boards.

What is clear is that the long-established maxim of prevention being better than cure still holds good. Politicians have been guilty of focussing on shiny big hospitals as being examples of their achievements in office. Of course we require adequate hospital provision, but keeping people out of hospitals for as long as possible through the efforts of all those working in primary care must be given sufficient funding and public recognition.

Malcolm Allan, Bishopbriggs.

JUDGING by the audience response during the ITV leaders’ debate last week, and Alan Roden’s article (“Why politicians can’t stop lying about the NHS”, The Herald, November 23) you could be forgiven for thinking the NHS is in danger of becoming a publicly owned service. NHS Scotland is certainly in need of reform. But, in order to reform, we need first to understand how the NHS presently operates.

Currently the NHS would crumble without private sector contractors. Most patients’ first contact with NHS Scotland is via the private sector – their GP. Crucial services are provided by GP surgeries, pharmacists, opticians, dentists – all of which are private sector contractors. According to ISD Scotland (the NHS information service), on October 1 this year, there were 1,935 GP practices. Of these, 94 per cent were private sector contractors and only 58 were run directly by an NHS board. Primary care in Scotland is heavily reliant on the private sector. Managed properly, paying public money to private contractors to deliver public services can lead to a diverse range of providers and help raise standards across the board.

Doug Clark, Currie.

NOT so long ago the First Minister wanted to “talk the talk” with the big league players, is she now going to “walk the walk” and take decisive action and remove the Health Secretary, not for alleged past mistakes by NHS Scotland but for her lack of veracity, empathy and willingness to communicate with those who deserve much better?

W MacIntyre, East Kilbride.